Hagspiel K D, Polak J F, Grassi C J, Faitelson B B, Kandarpa K, Meyerovitz M F
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115-6110, USA.
Radiology. 1998 Apr;207(1):139-45. doi: 10.1148/radiology.207.1.9530309.
To compare "cut-film" (film hard-copy) angiography (CFA) with digital pulmonary angiography in the detection of pulmonary embolism (PE).
Thirty-six adult patients (39 lungs) underwent selective digital pulmonary angiography for suspected PE. Imaging was repeated in one selected projection by using cut film. The standard was consensus interpretation of both CFA and digital angiographic images and clinical course. Three vascular radiologists subsequently reviewed the digital and cut-film images in a blinded fashion and ranked the likelihood of the presence of PE on a five-point scale. The two modalities were compared by means of receiver operating characteristic (ROC) analysis. Image quality (i.e., sharpness, opacification of subsegmental vessels, and exposure) was judged on a three-point scale. The highest-order pulmonary artery branch seen on each study was recorded.
ROC curve analyses for all three operators showed similar diagnostic performance for digital pulmonary angiography and CFA, with one operator showing better performance with digital subtraction angiography than with CFA (P = .04). Compared with the final diagnosis, single-plane digital pulmonary angiography had higher sensitivity for the detection of PE than had CFA. The specificity was 100% for both modalities. The mean score in patients with findings positive for PE was higher in the digital pulmonary angiography group than in the CFA group (P < .005). There was no difference in the mean score in patients who did not have a PE. There also was no difference in the smallest detectable subsegmental branch (P = .87) or in the average estimate of image quality.
Selective digital pulmonary angiography and CFA offer similar diagnostic performance and image quality. Digital pulmonary angiography is a reasonable alternative to CFA in the diagnosis of PE.
比较“切片胶片”（胶片硬拷贝）血管造影（CFA）与数字肺血管造影在检测肺栓塞（PE）方面的效果。
36例成年患者（39个肺）因疑似PE接受了选择性数字肺血管造影。在一个选定的投照位使用切片胶片重复成像。标准是对CFA和数字血管造影图像以及临床病程进行一致解读。随后，三位血管放射科医生以盲法审查数字图像和切片胶片图像，并以五点量表对PE存在的可能性进行评分。通过受试者操作特征（ROC）分析比较这两种检查方式。图像质量（即清晰度、亚段血管的显影及曝光情况）以三点量表进行判断。记录每项检查中所见的最高级肺动脉分支。
所有三位操作者的ROC曲线分析显示，数字肺血管造影和CFA具有相似的诊断性能，其中一位操作者显示数字减影血管造影的性能优于CFA（P = 0.04）。与最终诊断相比，单平面数字肺血管造影对PE的检测敏感性高于CFA。两种检查方式的特异性均为100%。PE检查结果呈阳性的患者中，数字肺血管造影组的平均评分高于CFA组（P < 0.005）。无PE患者的平均评分无差异。最小可检测亚段分支（P = 0.87）或图像质量的平均评估也无差异。
选择性数字肺血管造影和CFA具有相似的诊断性能和图像质量。在PE诊断中，数字肺血管造影是CFA的合理替代方法。
